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Choanal atresia is a rare congenital malformation that occurs approximately in 1:8000 live births. In about 40% of cases, it is bilateral and, very frequently, can be associated to other major craniofacial anomalies or visceral malformations as in the so-called CHARGE syndrome [1, 2]. In the newborn, the clinical manifestations of choanal atresia consist of respiratory distress strictly related to the entity of nasal obstruction [3, 4]. The surgical treatment employed in choanal atresia consists of both the trans-nasal and trans-palatal approach [5, 6, 7, 8]. The objective of this study is to present our experience in the endoscopic management of the choanal atresia and evaluate the effectiveness of the diode laser employment in the trans-nasal surgery of this congenital malformation.

From 1985 up to 2000, 43 children affected by choanal atresia were treated at the Airway Endoscopic Surgery Unit of Padua Hospital. Of these patients, 21 were males and 22 were females, with ages ranging from 1 day to 6 years (mean 10.2 months). In 34 cases (79%), the malformation was bilateral. We have observed associated anomalies in 10 patients (23.2%). Six of these presented a clinical picture of CHARGE association.

A retrospective review of children treated in our department for unilateral and bilateral choanal atresia was made. Following an endoscopic assessment with Hopkins telescope (video 1) and a CT study, all the children were treated with a trans-nasal approach under general anaesthesia and endoscopic control. In 33 patients, in the first 10 years of our experience, a trocar was used in order to perforate the bony atresia. From 1995 a contact-diode laser was employed in the treatment of this malformation (video 2), though in four cases, this laser was used to enlarge the choanal lumen after trocar surgery. Six patients, with a prevalent membranous plate, underwent the section of the atresia only by contact-laser [9, 10]. In 32 patients out of 43, all affected by bilateral atresia, an intranasal stent (Portex endotracheal tube) has been positioned and maintained from 3 to 6 weeks [11, 12]. In the patients treated only with laser, the use of an intranasal stent was not considered necessary [13].